Bone Marrow Transplant Financial Coordinator

Role Overview

• Verify insurance eligibility and benefits specific to the condition(s) requiring transplant services for all applicable coverages. Identifies third-party administrators and transplant carve out programs.
• Evaluates transplant candidates for financial funding or accurate financial sponsorship in conjunction with social work and the clinical team.
• Educates, screens, and assists transplant patients who do not have valid or active insurance coverage to enroll in third-party programs, interviews qualified patients for potential funding sources including Medicaid, financial assistance programs, and/or alternative funding sources.
• Submits Medicaid applications timely and accurately.
• Ensures the accuracy and completeness of all financial assistance and insurance documentation in the EMR and other related systems.
• Secures payer referrals, pre-certifications, and authorizations specific to all phases of transplant services and documents timeframes and included/excluded services.
• Coordinates scheduling of authorized/approved services with clinical and scheduling teams. Ensures authorizations are correctly linked to applicable accounts, transplant guarantors are created and attached with correct coverage(s), and bundled episodes are created and activated.
• Partners with payer relations and insurance case managers to facilitate the communication and documentation of Single Case Agreements (SCAs) and conduct operational analyses to meet specified objectives including monitoring commercial and governmental payer compliance for contracted negotiated rates.
• Determine patient personal financial responsibility, prepare estimates, assess ability to pay, and collect payments as appropriate. Maintains knowledge of payer contract terms and applies during payment calculations.
• Provide continued support once patients have been accepted into the transplant program; finalize and maintain financial clearance and prepare registration and admission documents.
• Prepare reports to investigate and provide meaningful explanations to support revenue, performance, and/or reimbursement fluctuations.
• Serve as a technical expert regarding transplant patient reimbursement, including the training and mentoring of staff, leading department goals and initiatives, and by participation as an active member of various transplant teams.
• Demonstrates the ability to work independently, be attentive to detail, and ensure work is completed timely and accurately.
• Identifies trends that may indicate problem areas and alerts leadership. Plays a key role in identifying and implementing solutions and ongoing monitoring of outcomes.
• Performs other transplant-related financial navigation duties as requested or assigned.

Requirements

• Experience: 3 years in healthcare or oncology related role in revenue cycle
• Education: High school diploma or equivalent